Unveiling hotspots and trends in hip arthroscopy research: A bibliometric and visualized analysis (1900–2022)

Over the past 10 years, hip arthroscopy has been increasingly employed to effectively diagnose and safely treat a range of hip pathologies. With research related to hip arthroscopy continually expanding, the number of articles connected with hip arthroscopy has also consistently grown. We aimed to investigate trends and hotspots in hip arthroscopy-related research, and analyze the top 100 most-cited articles on hip arthroscopy. We searched for (“hip arthroscopy”) AND (“article” OR “review”) AND “English” in the Web of Science database from 1900 to 2022, which was used to obtain all publications relating to hip arthroscopy. Distribution of country, affiliated institution, journal, authors, citation frequency and keywords were analyzed using VOSviewer. A total of 1094 articles were selected from the Web of Science Core Collection (WoSCC) from 1900 to 2022. The number of publications concerning hip arthroscopy displayed an ascending trend over time. Among the countries, the United States emerged as the largest contributor to the number of articles. The highest prolific institution was American Hip Institute. Among the journals, the highest-ranking journal was “Arthroscopy-the Journal of Arthroscopic and Related Surgery,” with 8316 citation counts and 262 articles. The area of greatest research interest was diagnosis and therapy in the field. The scientific articles on the subject of hip arthroscopy have risen continuously in recent years. The United States was the most influential country and made the most significant contributions to this field globally. We identified the research direction and trend for the first time and provided the most recent bibliometric analysis on hip arthroscopy, which may assist researchers in conducting studies on hip arthroscopy.


Introduction
With the advancement of endoscopy and minimally invasive techniques, hip arthroscopy is gaining increasingly significant importance in the field of joint surgery.Hip arthroscopy, a minimally invasive technique, is utilized to examine the internal structure and lesions of the hip joint.This technology allows visualization of the hip joint structure such as acetabular labrum, femoral and acetabular cartilage surface, fovea, ligaments, synovium and extraarticular trochanter. [1]According to related research reports, during the period of 2011 to 2016, hip surgeries increased 2.6 times, and the application of hip arthroscopy increased by 310%. [2]Furthermore, hip arthroscopy can significantly reduce morbidity and the risk of neurovascular injury and also shorten the recovery period compared to conventional hip surgery. [3,4]The benefits of hip arthroscopy are substantial, with a 2-year follow-up study showing that it can significantly improve symptoms in treating femoral acetabular impingement syndrome (FAIS). [5]With the increment in the number of hip arthroscopic surgery and its indications, [6,7] its related researches are augmenting day by day.Despite these studies, the overall trends and research focus on hip arthroscopy remain unclear.Thus, we use bibliometrics method for comprehensive analysis.
Bibliometrics, suggested by American bibliographers in 1969, is applied to statistically analyze the different information of books and other communication media. [8,9]Its strength lies in understanding the research dynamics in a specific field, and gives us a clearer picture of the distribution of authors, countries and journals in the study field, and may predict the trend of future research. [10,11][14][15][16] Given the advantage of bibliometrics and the need to understand the current state of hip arthroscopy research, we conduct a bibliometric study related to hip arthroscopy.
Our aim is to analyze the articles related to hip arthroscopy, explore the trend of studies, and help researchers quickly understand the research highlights related to hip arthroscopy.Till date, there has been only one review linked to the 50 mostcited articles of hip arthroscopy.However, this publication did not include author, keywords, research trend, and country collaboration.We endeavor to evaluate the articles on hip arthroscopy from various aspects including developing trends and direction of hip arthroscopy, research highlight, overall keywords, collaborating institutions, and countries.We hope that this study provides some guidance for future researchers in hip arthroscopy.

Material and methods
On April 14, 2022, we collected the information for our study from the Web of Science Core Collection (WoSCC).The WoSCC, widely used for bibliometric analysis, consists of an extensive collection of journals, authoritative books, and representative articles.The research methodology was as follows: Title = hip arthroscopy AND Document type = (article OR review) AND Language = English AND Time span = 1900 to 2022.

Analytical tools
To analyze our study, we applied VOSviewer (version 1.6.18)(Leiden University, Netherlands), Scimago Graphica (ver-sion1.0.38),CiteSpace (version 6.2.R7), Pajek (version 5.18) and Microsoft Office Excel 2019 (Microsoft, USA).VOSviewer, a user-friendly software tool, runs on the Java platform and is used to visualize and construct bibliometric networks.These networks may comprise researchers, countries and research organizations, keywords or scientific journals, connected by co-authorship, Co-occurrence, Citation, Bibliographic coupling, or Co-citation.VOSviwer basically uses the default values for bibliometric analysis, and if there are any special changes, they are detailed in the figure legend.
We utilized the software called Scimago Graphica, designed for exploring, visually communicating, and making sense of data, as a novel approach.Pajek is software for creating and analyzing networks of various types.Scimago Graphica and Pajek were used to further analysis of the data derived from the VOSviewer.CiteSpace is also considered high-quality software in the bibliometric field, thus it is utilized for data analysis.We employed Microsoft Office Excel 2019 to extract and analyze the relevant features of literature, such as title, author, journal, country, organization, publication years, total citations or journal impact factors, and create tables and figures.

Data extraction
After formulating the search strategy, 3 authors independently extracted the literature and bibliometric indicators from the data, and discussed any divergences until the consensus was reached.All of the data came from the WoSCC database in plain and Excel format and were extracted and analyzed using VOSviewer and Microsoft Office Excel 2019.

Publication trend
A total of 1094 documents of hip arthroscopy research were identified in the WoSCC database.Generally, the number of publications concerning hip arthroscopy has increased between 1980 and 2022 (Fig. 1A).From 1980 to 1992, the quantity of publications was the lowest, with research on hip arthroscopy even coming to a standstill.The number of publications experienced a steady increase of 109 between 1993 and 2012, indicating that researchers started paying more attention to hip arthroscopy.From 2013 to 2022, publication outputs have seen a steep ascent.

Distribution of country
The articles hail from 46 countries with the USA (n = 741) and Canada (n = 72) contributing significantly to the overall number of articles, 3 times that of other countries (Fig. 1B and  C).A visual network creating using VOSviewer and Scimago Graphica shows collaboration between countries (n = 26) based on the co-authorship.Only when those countries published 5 or more articles are they linked, and the size of the nodes represents the impact of the countries.the map is color-coded to represent different research directions.The proximity between nodes and the thickness of lines reflect the extent of cooperation between countries.The strongest linkage is observed between the USA and Israel (28), followed by between the USA and Canada (25.75), the USA and Australia (9.17), and the USA and Switzerland (7.25).Evidently, the USA has exerted an extensive influence on hip arthroscopy research (Fig. 1D).(Fig. 2A).There were 9 institutions from the United States Among the top 10 institutions.American institutions were the most active in hip arthroscopy research.The articles published by Hospital for Special Surgery have been cited the most (2399 times), followed by those from Rush University (1817 citations), and American Hip Institute (1760 citations) (Fig. 2B).

Institution distribution
Using VOSviewer software, a visualized network of coauthorship relationships between institutions was created.This network displays only the 77 institutions with at least 6 articles.
As the network reveals, the American Hip Institute has the strongest total link strength (n = 110), followed by Rush University (n = 65), Hospital for Special Surgery (n = 44), and American Hip Institute Research Foundation (n = 39).Rush University features the highest number of collaborators.Notably, the American Hip Institute collaborated closely with American Hip Institute Research Foundation and Hinsdale Orthopedics (Fig. 2C).

Journal of publication
In total, 147 journals published the identified 1094 articles.The top 20 journals account for 77.4% of the total publications

Keywords analysis and study hotspot
All keywords, inclusive of author keywords and keywords plus from articles on hip arthroscopy, which occurred at least 20 times were analyzed via the VOSviewer software (Fig. 3A).

Rank
The Maradit Kremers H [20] The Ross JR [3] The arthrography," "acetabular labrum."More recently, the keywords "femoroacetabular impingement syndrome," "risk-factors," "capsulotomy" and "score" have been gaining popularity in recently published articles.Figure 4 displays the top 20 keywords with the most potent citation bursts, the blue line signifies the base timeline, while the red line denotes the burst duration of a topic.The surge of keywords in this field commenced in 1999, with "diagnosis" (19.57) experiencing the strongest bursts, succeeded by "joint" (12.52) and "acetabular labrum" (10.51).Notably, "management," "United States," "arthroscopy," "femoral head," "complication" and "2-year follow-up" represent some of the current hotspots As portrayed in Figure 5, the 2 orange paths are the primary citation paths, signifying that research published in neurology/ sports/ophthalmology journals was principally cited by literature in health/nursing/medicine/sports/rehabilitation/sport journals.
The authors' articles on hip arthroscopy were analyzed using VOSviewer and further mapped with Scimago Graphica.Benjamin G Domb published the highest number of articles (126), followed by Shane J Nho, (97), David R Maldonado (64), and Ajay Lall (59).This collaboration network reveals that the authors generally worked together loosely, but there were also instances of close collaborations, such as Benjamin G Domb, David R Maldonado, and Ajay Lall (Fig. 6).

The top 100 cited articles
After ranking by the total number of citations, the top 100 most-cited articles were selected from 1094 articles published between 1981 and 2019 (Table 2).The period from 2010 to 2014 saw the highest number of articles published, with 38 articles, followed by the timespan from 2015 to 2019, which had 22 articles (Fig. 7A).
In terms of the top 100 most-cited articles, the Hospital for Special Surgery contributed the most articles related hip arthroscopic research, with 6 articles, followed by American Hip Institute, featuring 5 articles (Fig. 7B).
The majority of the top 100 cited articles originated from United States, United Kingdom, Canada, Australia and Sweden, and account for 91% of all articles.They were followed by Brazil, China, France, Germany, Mexico, Netherlands, New Zealand, South Korea and Switzerland with 1 article each (Fig. 7C).Notably, only China and South Korea represented Asian in contributing to these top 100 cited articles.
The top 5 scientific journals published the majority of the top 100 cited articles, including Arthroscopy-The Journal of Arthroscopic and Related Surgery with 41 articles, The American Journal of Sports Medicine with 16 articles, Clinical Orthopedics and Related Research with 9 articles, Clinics in Sports Medicine with 5 articles, and Knee Surgery Sports Traumatology Arthroscopy with 4 articles (Table 3).Although the number of articles published by The American Journal of Sports Medicine ranked second in the number of articles published, it held the first rank in impact factor, indicating a more extensive influence compared to other journal on the list.

Discussion
Hip arthroscopy has gained increasing popularity over the last 20 years. [19,22][25][26] The use of hip arthroscopy surged 5-fold from 2005 to 2013, making it one of the fasting-growing fields of arthroscopic surgery. [20]ome advantages of hip arthroscopy include lower rates of complications and reoperations, [4,21] which have led to a high rate of return to sport and work. [27,28]Considering the numerous advantages and rapid development of hip arthroscopy, this study aims to conduct a bibliometric analysis of hip arthroscopy, exploring and identifying the research foci and trends, as well as establishing a knowledge base for hip arthroscopy.It is hoped that this study will enlighten scientific researchers about the current research scenario in hip arthroscopy and provide future research directions.

Publication trends in hip arthroscopy scientific literature
The number of articles related to hip arthroscopy has seen a swift rise over the last 10 years, suggesting heightened interest among researchers.In terms of geographic distribution, the United States leads in publishing the highest number of articles on hip arthroscopic research, reflecting its leadership status in this area.While America spearheads the total number of articles on hip arthroscopy, Europe, Asia, Oceania and Africa have also made tremendous contributions.This illustrates that hip arthroscopy is a globally significant topic attracting international research interest.
In terms of institutional contributions, the American Hip Institute from the United States ranks first among all institutions for the number of articles published.The Hospital for Special Surgery, also located in the United States, has accumulated the highest total citations.This reality helps explain why the United States is a pioneer in this field.These institutions undoubtedly play an important role in hip arthroscopy research.The collaborative network among countries and institutions shows an encouraging trend toward greater communication between regions.The United States, leading both economically and scientifically, has fostered close collaborations with Israel and Canada.As possess adequate funding, advanced equipment, and professional researchers, these developed countries and institutions are more likely to carry out studies related to hip arthroscopy.Researchers interested in hip arthroscopy may consider partnering with these organization.
The top 5 prolific journals on hip arthroscopy include Arthroscopy-the Journal of Arthroscopic and Related Surgery, American Journal of Sports Medicine, Journal of Hip Preservation Surgery, Knee Surgery Sports Traumatology Arthroscopy and Arthroscopy Techniques-3 of which originate from the USA.This reflects that the United States places significant emphasis on healthcare and boasts superior scientific research capabilities.In addition, 3 of these journals have an impact factor (IF) >4.Therefore, when submitting articles on hip arthroscopy research, authors should give these journals more consideration.

Research focuses
The analysis of keywords in the field reveals that terms such as hip arthroscopy, femoroacetabular impingement, hip arthroscopy, surgery, and osteoarthritis have emerged and continue to be central themes.Prior to 2012, keywords included MR arthrography, traction, hip joint, diagnosis, indicating a primary focus on diagnosis and treatment.In more recent years, frequently used keywords such as acceptable symptomatic state, patient-reported outcomes, femoroacetabular impingement, revision, and highlight increased attention to prognosis.

The most influential publications
The most-cited article in hip arthroscopy, boasting a total citation count of 579 and an annual citation rate of 42.64, was published in The Journal of Bone and Joint Surgery (British volume) in 2009.Authored by Philippon MJ et al, "Outcomes following  hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum 2-year follow-up," evaluates the efficacy of hip arthroscopy for femoroacetabular impingement. [17]In this research, they concluded that patients very highly satisfied with the arthroscopic surgery of the hip for FAI, achieved excellent hip function.
The second most-cited article, titled "Prospective Analysis of Hip Arthroscopy With 2-Year Follow-up" was published in the Arthroscopy: The Journal of Arthroscopic and Related Surgery by Byrd JW and Jones KS in 2000. [18]To shift researchers' attention from indications to outcomes of hip arthroscopy, the authors collected data from 38 cases of hip arthroscopic surgery and examined postoperative situations.They concluded that while complications from arthroscopic surgery were not insignificant, they were acceptable for appropriate patients.Their studies acted as an impetus for further investigative research into hip arthroscopic surgery.
The third most-cited article in the top-100 list is titled "Trends in hip arthroscopy utilization in the United States," published in The Journal of Arthroplasty by Bozic KJ et al in 2013. [19]In this study, the authors used the American Board of Orthopedic Surgery (ABOS) database to retrospectively analyze the annual occurrence rate of hip arthroscopic surgery from 2006 to 2010.They also calculated and compared the complication rate of hip arthroscopic surgeries performed by newly trained surgeons taking the ABOS Part II Board exam with complication rates reported in published articles.The results showed comparatively low reported complication rates.Moreover, the incidence of hip arthroscopic surgery displayed a sharp increase, rising from 83 in 2006 to 636 in 2010.

Limitations
There are several limitations to our study that should be confessed.First, our data related to hip arthroscopy was solely obtained from the Web of Science Core Collection database, excluding other databases such as PubMed, Scopus and Google Scholar.Consequently, some key articles may have been overlooked, potentially resulting in an incomplete or superficial understanding.Second, we only selected publications between 1900 and 2022.Given that the database will theoretically evolve in the future, our analysis results may slightly deviate from the actual landscape.Third, non-English language articles were excluded, which may mean neglecting some valuable information.

Conclusion
This study demonstrates a fast increase in the number of published articles associated with hip arthroscopy over the last decade.The United States has emerged as a leader among other nations in terms of the number of scientific articles published.The American Hip Institute, Rush University and Hospital for Special Surgery have been the most productive organizations conducting research related to hip arthroscopy.The top 5 prolific journals publishing on the topic include Arthroscopy-the Journal of Arthroscopic and related Surgery, American Journal of Sports Medicine, Journal of Hip Preservation Surgery, Knee Surgery Sports Traumatology Arthroscopy, and Arthroscopy Techniques.Research hotspots receiving the most attention have been diagnosis and therapy, clinical description, and prognosis.Researchers interested in hip arthroscopy are encouraged to familiarize themselves with not only the top 100 articles but also the broader scope of this comprehensive analysis.It integral to have a deep understanding of these influential works and the trends they represent in this rapidly growing field.

Figure 1 .
Figure 1.Overview of publications.(A) Trends in the number of publications and citations on hip arthroscopy research from 1900 to 2022.(B) Distribution of publications.(C) The top 10 most active countries, the same color represent the same grouping.(D) Network map of country co-authorship, Minimum number of documents of a country: 5, Of the 46 countries, 27 meet the threshold, The country of Turkey was excluded as it exhibited no connection with other countries.

Figure 2 .
Figure 2. Highest impact institutions on arthroscopic hip.(A) The top 10 institutions in publications, the same color represent the same grouping.(B) The top 10 institutions in citations.(C) Network map of bibliometric co-authorship between institutions with 6 or more publications (n = 77).The thickness of the lines indicates the strength of the relationship, and the size of the node represents the number of published articles.

Figure 3 .
Figure 3. Co-occurrence analysis of keywords.(A) Keyword co-occurrence clustering network of hip arthroscopy.Each node in this map represents a keyword that occurred at least 20 times.Different colors indicated diverse research clusters, red for diagnosis cluster, green for basic research cluster and blue for clinical trial cluster.(B) Distribution of keywords according to average publication yr.Colors showed evolution of keyword over time (blue: earlier, yellow: later).

Figure 4 .
Figure 4.The top 20 keywords with the strongest citation bursts.

Figure 5 .
Figure 5.The dual-map overlay of journals pertaining to hip arthroscopy.Notes: On the left are the citing journals, while on the right are the cited journals, and the colored paths represent citation relationships.

Figure 7 .
Figure 7. Top 100 most-cited publications on hip arthroscopy.(A) Yr of publications.(B) Institutions with > 2 articles.(C) Distribution of articles by original country.(D) Publication topics.

Table 1
total of 982 institutions have contributed to the identified literature.Top 10 institutions, predominantly from the United Active journals on arthroscopy.

Table 1 )
. The top 5 journals were Arthroscopy-the Journal of Arthroscopic and Related Surgery, American Journal of Sports Medicine, Journal of Hip Preservation Surgery, Knee Surgery Sports Traumatology Arthroscopy, Arthroscopy Techniques.Regarding total citation times, Arthroscopy-the Journal of Arthroscopic and Related Surgery ranked first with 8316 citations but Hip: Aana Advanced Arthroscopic surgical Techniqures was the last one.However, Journal of Bone and Joint Surgery-British Volume ranked first with 94.7 citations as for mean citation times.The top 20 journals average impact factor was 3.02, which indicates that a high reliability of the studies included the journals.

Table 3
Journal with at least 1 of the most-cited articles on hip arthroscopy.